Back in 2004 I was seeing a Cardiologist because of AFib (since "cured" by an ablation).  The good Doctor wanted to put me on a Statin for reasons having to do with unexplained multiple "risk factors". Not being a big fan of legal drugs, I asked if I could try diet first. He said, "Sure, you can try the American Heart Association diet but...it never works".  Undaunted I tried it anyway and sure enough 3 months later I had gained 15 lbs and my LDL was even higher (I couldn't stop eating).  BTW, I quit the Statin 2 years ago and have been Paleo since. - Jay

No thank you,
bananas spike my glucose above 140, he he!!!

I think you are taking the article completely out of context. The monkeys were on the American Heart Association diet and then they added in high frutcose corn syrup. The monkeys got fatter because of the carbs from the corn syrup, not from the AHA diet. Personally I am paleo, but you are pulling a Glenn Beck here.

The point is not whether HFCS or wheat was the cause, but rather that all simple and refined carbohydrates will create the pot belly that Shiva and most of Americans have.  The animal cruelty police should spend their efforts in Washington protesting the plethora of garbage advice that is forced on us by organizations like the AHA and cut their funding.  By doing so, it will have a significant positive impact and help reverse the upward trends of obesity, diabetes and heart disease that your tax dollars go to perpetuate.  The AHA is one of the most corrupt and lobbied groups by special interests agriculture, the same folks who bring you the refined carbs.  Once the agriculture industry checks clear in the AHA bank account, the AHA "heart Healthy" seal of approval is on the box.  If you bother to look most of the AHA "Heart Healthy" cereals have refined cereals grains and high fructose corn syrup.

Researchers in England and Singapore have developed a device which can assess the risk of heart disease.

http://insideireland.ie/2011/02/21/watch-like-device-to-assess-heart-disease-risk-9317/

I have followed this blog for sometime. I do appreciate Dr Davis's efforts and the comments made in the blog.
But I think he needs to address the criticisms made in the previous blog entry. Completely ignoring the comments and questions and moving onto a new topic seems to point toward an unseemly arrogance and a lack of respect for the readers.

Um, click on the link, but prepare for a very sad sight, the poor guy, (or girl) looks miserable.

What's Dr. Davis' alternative to AHA? Is it in a book or something?

As an alternative to the AHA and the ADA dietary guidelines,see Jenny Ruhl's two sites for a start.

Blood sugar 101
http://www.phlaunt.com/diabetes/

Low carb dieting
http://www.phlaunt.com/lowcarb/index.php

To all the entitled anonymous douchebags, if you don't like what Dr. Davis says in his blog leave! Dr. Davis doesn't work for you.

Two weeks after no dairy, no wheat and some really delicious juicy steaks I am five pounds lighter and feel great.
I don't give a rip what my lipids are because I am not going to do anything any differently anyways!

Blood sugars never break 100.

@second Anonymous- try reading the article before criticizing Dr. Davis for mischaracterizing it.  You'll see he was correct.

@Anonymous #2, the group on the HFCS drinks (among other things) and the group on the AHA diet were two different groups of monkeys:

"Dr. Grove [of Oregon Health and Science University] and researchers at some other centers say the high-fructose corn syrup appears to accelerate the development of obesity and diabetes....

“'It wasn’t until we added those carbs that we got all those other changes, including those changes in body fat', said Anthony G. Comuzzie, who helped create an obese baboon colony at the Southwest National Primate Research Center in San Antonio.

"Still, about 40 percent do not put on a lot of weight.

"Barbara C. Hansen of the University of South Florida said calories, but not high fat, were important. 'To suggest that humans and monkeys get fat because of a high-fat diet is not a good suggestion', she said.

"Dr. Hansen, who has been doing research on obese monkeys for four decades, prefers animals that become naturally obese with age, just as many humans do. Fat Albert, one of her monkeys who she said was at one time the world’s heaviest rhesus, at 70 pounds, ate 'nothing but an American Heart Association-recommended diet', she said."

The article goes on to refer to the first diet as "high fat," even though it's only 33% fat, and the way the article is written, it's hard to tell the groups apart.

Take the banana; a banana a day for one year offers hormetic (small bit of bad does good) low dose radiation of +/- 3.6 milli-rems for the entire year. Low dose radiation boosts the cytokine activity of NK (Natural Killer), the tumor stopper. A chest x-ray doses out 10 milli-rems by comparison.

Potassium , found in bannanas, is 0.0118% K40 isotope potassium. It emits mostly gamma radiation (when proton snags an extra electron) and some beta particles (when neutron mass spins off an electron and neutron becomes a proton); which are "slow" in collision with things, like a cell.

To a recent "Anonymous":

Dr Davis does have have an obligation to his readers. By convention, he is expected to explain himself and respond to polite and appropriate questions regarding his blog. That is why the interaction is provided, and he seems usually to encourage the dialogue. Dr Davis could have just as easily established this blog without the interactive feature. Currently, among usual glowing reader comments and often enlightening questions has come some criticism. His response to this criticism is what is currently lacking ... of course, this is only my opinion.

By the way, I am not exactly sure what "entitled anonymous douchebags" have to do with anything.

RE: “blah blah ... completely ignoring the comments and questions and moving onto a new topic seems to point toward an unseemly arrogance and a lack of respect for the readers.” by anonymous.

Fortunately, commentary on this excellent blog is for the most part constructive and informative. However a comment like this is frankly annoying because it’s mean-spirited, disingenuous, cowardly, and clearly not helpful. The poster is not obliged to read this blog, let alone dump on it like this anonymously!

Interesting!  I have been advising a woman who works in a chimpanzee sanctuary in the North West.  There is one chimp who had blood sugars of 1000.  

Sadly, they have put this chimp on Crystal Light and Tofu as a remedy.  

Chimps share 99% DNA with humans.  We know that aspartame and soy are both dangerous to the human body.  

The most interesting thing is, she rebelled when her goodies were taken away.  

They too are addicts just like us.

You're the only doctor I trust. The more i see the changes in my BP and overall health following your advice, plus the more I learn about what should first be done to treat hypertension, the more pissed off I get.
What jerk puts a young woman on atenolol without even asking for some tests or if she eats too much salt or if she's wound high at the dr's office!!?? What the hell!?

BTW, my blood pressure has dropped even more- an average of around 121/81- from 151/102. This is with 12mg of atenolol which I should hopefully kick to the curb soon

Hi Misty,
Although chimps and humans share 96% identical proteins the implication of our intervention is complicated. Here's why.

We actually have 40 million genome variables, including 500
DNA repair/apoptosis pathway proteins. 5% of proteins show different splice variations; we have different arrangements of coding regions on the chromosomes we share.

Chimps have 2.5 splice variations in places where humans only 1.5 gene splicing possibilities. 80 proteins we share similar gene intron segments for the chimp's intron is longer. Humans have more genetic activity post-translation to further modify events.

Humans don't have Neu5Gc (N-glycolyl-neuraminic acid) which is a sialic acid binding immuno-
globulin-like lectin (Siglec). This mediates molecules of sialic acid to perform differently. It directs what gets bound; the result is spleen macrophage response for chimps immune system works differently.

The chimp ligand (thing that binds to something) processing mechanism extends to how they metabolize estrogen and phyto-estrogen iso-flavenoids (like soybeans contain). They pass both ligands, like wheat lectins, and estrogens more fully in their urine than humans do.

For chimps a high fat diet causes less urinary excretion of estrogen, as well as less of the fragments of peptides from lectin ligands. To be precise high protein and high carbohydrate diets also diminish those metabolites % in chimp urine; just less so than high fat.

Dr Davis,

I have just found your blog because I have only recently begun searching for dietary info in order to guide me in rebuilding my skeletal muscle (and brain) after a so-far-11-month bout of severe adverse effects to a statin.  (When prescribed my readings were: Total Chol 297, HDL 117, LDL 165, triglycerides 73 – after 2 months of little exercise as the result of pneumonia and eye surgery.)

The widespread acceptance of the "Paleo" diet interested me greatly, because I independently came to some of the same conclusions several years ago.  There is, however, a big Something that I don't understand and that I haven't seen addressed.  I hope you can – briefly, I know – educate me.  Why such severe restrictions on carbs when they were so important in our survival?

The characterization of Paleo as high protein, high fat, low low carbs doesn't square with my college science courses and subsequent reading.  Early, early man would have grubbed around for whatever he could find, and, yes grubs would have been eaten were he lucky enough to find them, as well as other insects, wounded  small game, carrion, and fruit/berries/nuts.  Early man would also have discovered ROOTS and TUBERS very early on, and wild pea pods and the like, long, LONG before he was capable of running down game alone or in concert, or could even be sure of modest, reliable supplies of protein and fat.

And once he was a hunter, then what?  Not much fat on wild monkeys and stressed hooved animals (lots of other predators were after them, too), and one had to live between those perhaps widely spaced hunts that were successful and had to be shared.  More ROOTS and TUBERS – because fruit alone tends to leave you hungry for more (the fructose), whereas a nice raw potato, a few carrots, could calm the gnawing in the stomach.

Yes, I see that we now need considerable protein and a lot of fat (compared to current guidelines) because as we progressed  our expanded diet of increased amounts of protein and fat permitted our brains, especially, and our bodies to evolve to take advantage of such nutrients.  But I can't agree with the demonization of a large segment of our natural food supply.  Cut out grains.  I can see that.  But the sweet potato?  In the skin?  With generous amounts of butter gilding its fiber-rich goodness?

Why?

This may clarify, in their recent 2010 paper, M Konner and SB Eaton, estimate the ancestral diet (as % of daily energy) composed of
   35-40 acrbohydate,
   25-30 protein, and
   20-35 fat.
They comment that the carbohydrate source for “hunter-gatherers” (HG) was from fruit, vegetables, and nuts, not from grains. They go on to say that the reduction of carbohydrates to extremely low levels is not consistent with the HG model, but neither is a high-carbohydrate, “meat as a condiment” type of diet.

Konner and Eaton, both physicians, published their seminal paper on Paleolithic nutrition in 1985. The statistic above comes from their most recent paper of 2010. For those interested in how the popular interpretation of scientific research tends to “spin” the original detail, references to both their papers are below. Unfortunately, the 1985 article in the New England Journal of Medicine is restricted to paid subscribers only, while the recent invited article in Nutrition in Clinical Practice is available free online.

Eaton SB, Konner M. Paleolithic Nutrition: A consideration of its nature and current implications. N Engl J Med. 1985 312:282-289.

Eaton SB, Konner M. Paleolithic Nutrition: Twenty-five years later. Nutr Clin Pract 2010 25:594-606. http://ncp.sagepub.com/content/25/6/594

There seem to be a few anonymous people making posts giving their opinion about how this blog should be run. Some of their assertions remind me of the entitlement mentality ruining this country.

First, Dr. Davis is under no obligation to answer anyone's comments or questions.  How much do you pay to come here and read? I thought so.

Second, when he chooses to respond, understand it is taking time out of his day that could go to his medical practice, (Real clients who pay for his services) his family, or without knowing the man personally, his hobbies or other interests.  How much time do you think it would take to write an answer to each person who poses a question in the response section on this blog?  Keep in mind how much slower writing is than speaking! It would take hours.

Maybe it hasn't occurred to some of you that an answer to one person in the comments section won't be seen by very many people.  A much better use of his time is to write a short blog post at some time in the future that will be seen by many, and will be search-able, rather than answering the same question over and over again in the comments section.

It's not all about you, people. Get a life.

Worldinside, first, there's no one paleo diet. At certain times and places, like Cro-magnon Europe, the diet was nearly all meat. Paleolithic humans ate animals (snout to tail, not just muscle meat), fruit (in season), and, yes, tubers when they were available.

Second, probably unlike Paleolithic humans, many readers of this blog don't have normal blood glucose reactions to carbohydrates. As you probably know, carbohydrate consumption spikes blood sugar even in normal, healthy people. In people with diabetes or metabolic syndrome, eating a tuber can cause BG levels that can lead to organ and tissue damage. Overconsumption of carbs over a month in such people can lead to high triglycerides as well--not to mention weight gain.

While it's useful to look at how Paleolithic humans ate, we also need to look at medical science and keep our own individual quirks in mind. Humans need to eat protein. We also need to eat fat; we can't make essential fatty acids ourselves, and dietary fats have a unique ability to allow us to absorb vitamins A, D, E, and K. But there's no such thing as an essential carbohydrate (people who have hypoglycemia aside). Our liver can make blood glucose from protein. And just because something is natural and somebody else can eat loads of it, doesn't mean everybody can eat it.

Assuming your goal is longevity and health in old age, it doesn't matter what our hunter-gatherer ancestors ate, because they didn't live much beyond age 70, which is quite young by modern standards. Living to 100 and being healthy in your 90's is very unnatural, so it follows that those of us who want to live that long should eat unnaturally. All the evidence I've see suggests that being lean and conditioned is the way to go, regardless of diet, but that a mostly vegetables diet is most conducive to longevity. Eating mostly grains is also okay. Eating high-fat or high-meat is NOT conducive to longevity.

If you are not lean and conditioned, then first priority is to become lean and conditioned, and any diet which helps towards this primary goal is a good diet. Only after you become lean and conditioned do you really need to start worrying about diet.

… as always such enlightening comments …

In my neighborhood, it is generally accepted that the life expectancy at birth for preindustrial populations was 30-35 years. This was due not to the absence of older people but due to the extremely high infant and child mortality. Deaths overwhelmingly were due to infectious diseases that are now under control, more or less. With the longer average life spans came the advent of the diseases of civilization: atherosclerotic cardiovascular diseases, type 2 diabetes mellitus, chronic obstructive pulmonary disease, lung and colon cancers, essential hypertension, obesity, diverticulitis, and even dental carries. As of 2011, US life expectancy at birth is 78 years.

For sure, aerobic fitness is essential to health and longevity in the modern world however, medical science has demonstrated that many of the diseases of civilization would be minimized with appropriate dietary modification. Yes, the same medical science that we are throwing rocks at in the current “cutesy” survey of the AHA offered in this blog session.

One method of analysis in medical research is the examination of the Paleolithic diet supporting the discordance hypothesis that tries to explain that the mismatch in our modern diet from that what our genome has evolved is the cause of some chronic diseases. As an example, consider the modification of sodium intake. Studies of our ancestors diet estimates their sodium intake at about 800 mg/day, compared to a current adult average of 10,000 mg/day estimated by the WHO. Well-validated computer simulations predict that a reduction of 3000 mg/day (30%) in sodium intake would result in 40,000 to 90,000 fewer deaths from coronary heart and stroke each year in the US. On the other hand, moderate ethanol intake has been shown to reduce cardiovascular risk. Ethanol consumption was probably nonexistence before the invention of agriculture and not part of the paleo lifestyle.

No one has all the answers but blindly following any particular lifestyle or lifestyle advocate will probably not get you to a healthy 9th decade or simply a healthy older life. However, with a little luck and the judicious adoption of demonstrated healthy habits in fitness, nutrition, and lifestyle we all may get there.

I think the problem people have with The Heart Scan Blog is that they forget the doctor is referring to people who have metabolic problems. I've met many people who are fat and who eat potatoes and fruits yet keep their cals low and lose a ridiculous amount of weight. But at the same time I know people who, if they ate the same way, they would gain weight.

In general, the info on this blog is really good. Sure there are times where it seems that the doctor has recanted his hate of weight so much that he begins going after the most random stuff (i.e.. butter), but realize that this is a blog and that - as mentioned previously - everyone is different.

Closing anecdote: My grandfather is 94. He's incredibly healthy (runs a whole mango farm in Asia). His diet would be deemed bad by most of the people on this blog. He eats oatmeal topped with mangoes for breakfast, Hawaiian Bread with SPAM sandwich (because he's out on the farm), and he eats white rice for dinner. His cholesterol is perfectly fine. His heart is perfectly fine. In fact, the doctors are always amazed at how healthy it is.

So it goes to show, it depends on YOU. Do your research, see what info is out there, don't rely entirely on any one source of info. So a doctor recommended you a diet you don't agree with? Guess what? Go see another doctor! Just be sure you aren't going from one doctor to another until you hear the answer you WANT to hear as opposed to the one you NEED to hear.

Thank you to all the  Anonymousi, Lori and Revelo who replied to my question, especially the first responder.  I've downloaded the paper and am looking forward to reading it.  I was pleased to note that, as I believed, those early diets were pretty well balanced.

And thanks, Lori and another, for pointing out that this site is intended largely for people with CVD and/or metabolic disorders.  (That explains the every 15 min BG readings!)

I was not questioning because I was confused about which diet to follow, but rather, was confused by the way the term "Paleo" [diet] was being thrown around on this site by several commenters, as in "I've been Paleo for two months now and feel great.  No more carbs for me."  And I wondered if that was the site terminology for the diet plan envisioned by Dr Davis.

Revelo, I don't think I agree with your statement, " Only after you become lean and conditioned do you really need to start worrying about diet."  First of all, unless you've a metabolic disorder I think you should be mindful rather than worrying about your diet.  Second, I'm inclined to believe that once you're conditioned that's when you can stop worrying, if you were so inclined.  You've cranked up the mitochondria and they're working away at increased effectiveness even while you're not working out.

By the way, I used to love oatmeal in the morning.   Several years ago I started what turned out to be about two years of oatmeal for breakfast every single morning – with half and half or cream and brown sugar.  Then I stopped as suddenly as I had started.  I think my body needed something the oats supplied, and then it no longer did.  And I stayed slim all that time.  Now I don't touch fructose except in fresh fruit (Thank you, Dr Lustig), so no sugar either white or brown should I ever again get the oatmeal urge.

To all the "anonymous" posters-

After reading Dr. Davis' blog for some time now, I can assure you he will respond if the comment is worth his time.

General bad mouthing is rampant on a blog and if he spent most of his time refuting narrow minded opinions he wouldn't have time to be a cardiologist or write. So chill out or go elsewhere.

Also- his views aren't directed to just people with metabolic syndrome. It's for people who seem to be the American picture of "health" but are a ticking time bomb for diabetes, stroke, heart attack. His knowledge delves deeper than just a typical lipid panel (LDL, HDL, triglycerides).

People should know what they speak of, before the pop of at the mouth about topics they aren't well suited to debate.

Good post Dr. Davis.

Anonymous February 23, 2011, said "…. after looking it over following a very strong recommendation, I can say that I will not be back."

Thank you anonymous - based on your silly comment from which I took the quote, you have absolutely NOTHING to say. I am delighted you are going.

r Davis, thank you for yet another informative, intelligent post.

Some are not abreast of the science and how it is clinically relevant. A 33 year 14,000 patient study of Danes, published 18 Feb 2011 in Annals of Neurology, indicates Doc's insistance is well founded.

(In case you wonder why neurologists' data are relevant it is because 87% of fatal strokes are ischemic strokes. Now on to the science reported.)

Danes followed those with strokes over 33 years and found that NON-fasting triglyceride levels were more of an indicator than cholesterol level.
Specificly: women and men with over 89 mg/dl NON-fasting triglycerides had 1.2 times more stroke risk.

Doc's rants about blood sugar after eating, including butter induced spike, are in line with NON-fasting triglycerides being
a risk factor. He does detail
triglyrerides in other posts and goes into the VLDL mechanism too. My layman's focus on LDL & genetics overlooked what this blog clued me in to.

Laboratory lipid blood work shows the fasting trigylceride number. Doc pushes home test of
post-meal blood sugar since it is a surrogate of VLDL and NON-fasting triglycerides getting elevated (or not).

Non-diabetics, like me, think blood sugar science is for the other guy. Doc seems to be trying to hammer it home that it is relevant to some more of us.

Let's focus on coronary problems, like multi-vessel coronary disease, although it is all tied in to cardio-vascular "events". A meta-analysis of 20 studies covering 90,000 non-diabetics is worth summarizing.

Over 12 years those 90,000 non-diabetics' heart risk (multi-vessel coronary artery disease) correlated exponentially with both fasting and post-meal blood glucose levels. This was irregardless of the person not meeting the diagnostic criteria for being diabetic; and irregardless of "normal" fasting blood sugar, or even signs of glucose intolerance. In other words, the +/- 2 hour span of blood sugar dynamic is connected to cardio-vascular events.

(Multi-vessel coronary disease is when the left ventricle functions, but there is +/- 70% stenosis narrowing of blood vessel from plaque.)

European Diabetes Epidemiology Group's 2003 "DECODE" research shows that the interplay  of blood sugar and cardio-vascular risk can start even in the "normal" blood sugar range. The risk progresses in a linear
fashion, yet there is no specific point where can say individual has passed the point of no return into danger.

Again, the DECODE data's
significance is that post-prandial (after meal) glycemia, and to a lesser extent fasting blood sugar level, is relevant to cardio-vascular events even in some non-diabetics.

Non-diabetics can still share some of the 30 risky genes with type II diabetics and yet not become diabetic. We don't know which of us has what of those allelo-morphs (a.k.a. allele; a DNA sequence on a chromosome).

So, non-diabetics (specificly those with the alleles similar to diabetics) may have normal fasting &/or normal post-prandial blood sugar yet be at risk of a cardio-vascular event. Furthermore, non-diabetics with suspiciously elevated fasting blood sugar are thought to be manifesting one of those genetic SNPs (single nucleotide polymorphism, a.k.a. mutation).

Clinically 35% of diabetics have cardio-vascular events and 5 years later 35% of those go on to have a fatal incident. In comparison 24% of non-diabetics have cardio-vascular events, yet 5 years later 33% of those who share the risky allele(s)go on to have a fatal incident. In other words, everybody who took a first "hit" has virtually the same chance of dying; speculation is the non-diabetics who go on to die share the dying
diabetics risky allele(s).

Discussing what (say) grand-dads
eating habits is annecdotal; as is we non-diabetics assumption time won't alter things for us.
Many of us do not share genes with any diabetic risk, so Doc's "gluco-phobia" is irrelevant. He obviously
sees plenty, diabetic and non-diabetic, who come to him so they won't die unnecessarily.

For you who may live long enough to see routine testing, or doing research, here is a list of the 10 alleles most associated with European ancestry adult onset diabetes relevant to what was discussed above.

It bears mentioning that each may have up to 3 allele sub-variations for each risk
gene. In no particular order, they are:
FTO rs8050136, IGFBP2 rs4402960,
CDKAL1 rs7754840, HHEX rs1111875,
SVC30A8 rs13266634, PPARG
rs1801282, KCNJ11 rs5219, TCF7L2
rs7903146, CDKN2A/B rs10811661and rs93000039.

Wow. I see I enter a fascinating conversation.

In response to a question posed by Worldinside: The difficulty with carbohydrates differs substantially from person to person, based on 1) genetics, e.g., apo E2, 2) intensity of physical activity, 3) preceding lifelong carbohydrate exposure, 4) current weight and insulin sensitivity, 5) vitamin D status, 6) lectin content of consumed foods. There are other factors.

Point: There cannot be a one-size-fits-all approach to diet. This is one of the main reasons I advocate postprandial glucose checks, a means to assess a specific individual's carbohydrate tolerance.

And thank you, Eric and Terrence, for understanding that this is a blog and that I do my best to respond, given my time constraints. I've just finished a 10 hour day in the office, spent 2 hours starting in the early a.m. editing a new book (to be released by Rodale in fall). I now turn to website responsibilities until late tonite.

There's only so much you and I can fit into a day.

Can't wait for the new book, the first one was truly a God send.

Does it have a title yet?

I find this blog to be very helpful in sorting out what to eat and how it may effect me.  
I have increased the amount of Vit D and fish oil that I take daily.
He is providing a good public service with the blog for which I thank him.

Dr. Davis- I've been following your blog for a while now and always enjoy your posts! Informative for sure - both the posts and all of the comments.  Your sign off question gave me a good giggle.  Keep up the good work!


artsynina.blogspot.com

@Kent

You can read the already written chapers of the book if you log in to the TYP site: trackyourplaque.com.

This blog is always giving good information. This is really good health blog. This is also really good article.

The American Heart Association had always given good advice on caring for one's heart. It is up to us if we heed them or not.

buy pgx

I have hard evidence that he was killed by the Freemasons because he was about to reveal secrets about the Illuminati and the New World Order. It was made to look like a heart attack by the same people who tried to cover up the UFO crash at Roswell.

I also have passages from the Bible that show exactly how this incident will effect global warming.

Okay, I'm feeling sufficiently guilty just reading this.  Yes, I know intellectually about postprandial lipid surges and such... but given that in the real world sometimes we are caught in situations where there isn't a lot of healthy foods available:  By way of instruction, how could the Good Father have salvaged these situations from disaster?  What choices could he have made in these situations which would have been better, healthier (yes, I know about the lunch pail and packing good, healthy foods to take from home, and do it all the time).  But WHAT IF he didn't have the option of bringing his own food to a restaurant or social "fish fry" situation?  What to do then, constructively, besides a heavy dose of guilt?

We use an EMR and recently on the online forum for the EMR, an MD posted a question about an error message he received when he transmitted an rx electronically to the pharmacy.

He said he had written for 50,000 IU of Vitamin D (weekly x 8 weeks) and during the transmission, the comma was dropped so the pharmacist received a RX that only read "50 IU."

The MD posted the issue b/c he wanted to know if others were having the same problem with RXs that contained a comma.

I replied to the post and answered his technical question, but was disappointed in his choice for intervention. I didn't reply with any info about D2 versus D3 (who am I to educate a physician about medicine?) but in hindsight, I probably should have. Who knows how many other people will receive suboptimal Vitamin D treatment.

P.S. If you need a good laugh, grab a copy of the latest AFP magazine and read the D article. Their suggested intervention for D deficiency....50,000 IU D2 for 8 weeks. Yauzers.

I might keep the article for historical significance. My hope is that in just a few short years, we'll look back on such non-sense and be proud of how far we've come with treating D.

P.P.S. I'm going to the Vitamin D conf in Toronto on Tuesday! I cannot wait!!

The way the nurse kept asking if it was okay to have the patient take the D2 tablets, I couldn't help wonder if the pharmacist was getting a kick back for those tablets. What also bugged me was how she didn't want to "hear" or honor what you had to say even though you are the patient's doctor. Not good.

I'd LOL if it weren't so sad.

BTW, I've gotten two doctor neighbors and family on vitamin D and probiotics.  One is egotistical, the other grateful.  Thanks for all you do.

So they needlessly increased her costs? Great :/

You know, I don't bother telling doctors exactly how much D3 I'm taking. I just get them to check my blood levels and they see no problems with the results. But they would probably balk at the fact I take 10k per day.

I am a bit disgusted about this whole thing. This shows ones again how stupid the whole industry is… I was just recently at my doctor to take a few tests after some horrible years on the birth control pill Yasmin (it had basically taken me 7 years to put two and two together because no doctor would believe my symptoms well at least not connect them to the birth control). He asked me why I was taking all these vitamins and supplements – Preventive maintenance, was my answer. No comment back except for a smirk. Well yesterday they called me to tell me that everything was ok, but didn’t understand why I wanted to see my own lab results… the woman I was speaking to almost questioned my motive for wanting to see it. What the heck is wrong here… ???

Nutrient Biomarkers Analytical Methodology: Vitamin D Workshop
The National Institutes of Health (NIH) Office of Dietary Supplements (ODS) is sponsoring the Nutrient Biomarkers Analytical Methodology: Vitamin D Workshop on Wednesday, December 16, 2009 at the Bethesda North Marriott Hotel & Conference Center, Bethesda, Maryland.


Workshop Summary
Vitamin D is a fat-soluble vitamin that is naturally present in very few foods, added to others, and available as a dietary supplement. It is also produced endogenously when ultraviolet rays from sunlight strike the skin and trigger vitamin D synthesis. Vitamin D obtained from sun exposure, food, and supplements is biologically inert and must undergo two hydroxylations in the body for activation. The first occurs in the liver and converts vitamin D to 25-hydroxyvitamin D [25(OH)D], also known as calcidiol. The second occurs primarily in the kidney and forms the physiologically active 1,25-dihydroxyvitamin D [1,25(OH)2D], also known as calcitriol.

Serum concentration of 25(OH)D is the best indicator of exposure to vitamin D from all sources. It reflects vitamin D produced cutaneously and that obtained from food and supplements. There is considerable discussion of the serum concentrations of 25(OH)D associated with deficiency (e.g., rickets), adequacy for bone health, and optimal overall health. In fact, different assay methods are used to assess 25(OH)D. The methods themselves vary and there are considerable differences among laboratory results even when they use the same method.

Given the uncertainties in vitamin D measurement, the NIH/ODS will host this one-day workshop to evaluate the state of analytical methods. The intent of the Nutrient Biomarkers Analytical Methodology: Vitamin D Workshop is to develop strategies for resolving inconsistencies between results obtained following quantitative determination of selected nutrients in biological materials such as serum when different measurement techniques are used. The desired outcomes of this meeting are to identify strengths and weaknesses of analytical approaches available for the quantification of the nutritional biomarker of Vitamin D status, circulating 25(OH)D in biological samples and to discuss analytical methods, including criteria for selection of method(s); role of reference methods and samples; sample preparation and interpretation of results.

The workshop will consist of a series of short, focused podium presentations interspersed with open discussion sessions on the currently available analytical methods and interpretation of findings. A final session will summarize the discussions, identify knowledge gaps, and suggest a research agenda for future studies.


Registration
Space is limited and will be filled on a first-come first-served basis. There is no registration fee to attend the workshop. To register please forward your name and complete mailing address including phone number via e-mail to Ms. Tricia Wallich at twallich@csionweb.com. Ms. Wallich will be coordinating the registration for this meeting. If you wish to make an oral presentation during the meeting, you must indicate this when you register and submit the following information: (1) a brief written statement of the general nature of the comments that you wish to present, (2) the name and address of the person(s) who will give the presentation, and (3) the approximate length of time that you are requesting for your presentation. Depending on the number of people who register to make presentations, we may have to limit the time allotted for each presentation. If you don't have access to e-mail please call Ms. Wallich at 301-670-0270.


Workshop Details
Agenda

Meeting Location:

Bethesda North Marriott Hotel & Conference Center
5701 Marinelli Road
North Bethesda, MD 20852
Phone: 301-822-9200
Website: http://bethesdanorthmarriott.com

http://ods.od.nih.gov
What profit is there for one to gain the whole world yet lose or forfeit himself? Luke 9:25

Dr. Davis,
Great post, I enjoyed the way you wrote the dialogue between you and the nurse at the hospital--very, very realistic, and kind of spooky at the same time.  Unfortunately, this is just the tip of the iceberg--from my own personal experiences with my type 2 diabetic father in the hospital, getting insulin right is a total nightmare.  They use this arbitrary sliding scale which in some cases is totally ineffective and makes for unnecessarily high sugars--I remember how my father was merely 2 days post-op and was sitting there furious because the staff thought it was okay for him to be lying there with sugars in the low 200's, based on their scales and protocols.  
You've got to stay out of hospitals.
Great post.
Adam

Well good luck getting anything "health promoting" while in a hospital!

Last year, while hospitalized for a bout of Takotsubo syndrome,  they wouldn't let me use my own: fish oil, Vitamin D3, Vitamin K, multi-vitamin, compounded bi-est or progesterone, and so on...

They did manage to have Armour thyroid available to dispense to me.  Instead of the bi-est and progesterone they offered me Prempro... shudder, and these two meds could be had at the hospitals nifty pharmacy prices.

So 4 days without the vitamins probably did no harm... but the hormones???  Yikes, by the 2.5 day mark my husband was forced (by me) to become a criminal and smuggle the compounded meds in to me during the night.  What could they do to me that would be worse than hormone withdrawl on top of Takatsubo syndrome?  HA... don't answer that!

I got better as quickly as I could, and got the Heck out of there.  BTW, I don't think anyone on the nursing staff understood the difference between a heart attack and Takatsubo syndrome... BIG difference!

Oh... and I got rid of the "precipitating event" that caused the whole thing, and that has greatly de-stressed my life.

My advice: stay away from hospitals if at all possible... unless you are a doctor, nurse or hospital administrator.

madcook

Great post, and great comments, especially this one from Helena:
"Well yesterday they called me to tell me that everything was ok, but didn’t understand why I wanted to see my own lab results… the woman I was speaking to almost questioned my motive for wanting to see it. What the heck is wrong here… ???"

That sounds so familiar. If I could just go directly to a lab without doctor's orders, I would almost drop completely out of the whole doctor and hospital system.

I hope I never have to go in the hospital.  They will probably feed me the standard "diabetic diet," low fat-high carb, and send my blood sugar into orbit.

They do seem very reluctant to tell you the numbers.  After my last blood test, the nurse called and said my cholesterol was "high" and the doctor prescribed simvastatin.  I had to pry the numbers out of her:  LDL - 128, trigs - 55.  I consider the "high" LDL to be a case of skewed freidenwald and haven't bothered with the simvastatin.

Note to Jim Purdy:  You can get your own tests.  
www.MedLabUSA.com
www.MyLab.com
www.HealthCheckUSA.com (I think the .com is correct but not sure.)

Jim-

Try these self-directed lab test companies:

www.directlabs.com

or

www.privatemdlabs.com

I've used both of them a lot.  PrivateMDlabs even gives you a 15% discount on top of their reasonable lab test prices.

Rich

JPB,

You make a good point.  In most states, it is possible for people to go directly to labs.  However, I want to point out that a few states, including NY, prohibit people from dealing directly with labs unless you are a licensed medical practitioner. New Yorkers can't even participate in the Vitamin D project.  It's infuriating, and I think it encroaches on basic liberty.

Any guess on how much the hospital charged the insurance company for that single pill of second rate Vit D?

Living in New Jersey, I too suffer from "nanny-state" laws which prohibit me from getting my blood drawn for direct-to-consumer testing in New Jersey.

However, it is perfectly legal to order the tests and get the labwork done at a Labcorp (usually the draw site used) in a neighboring, less-restrictive state.

I am fortunate to live in southern New Jersey 20 miles from Philadelphia, so I get my lab draws by going over the bridge to Pennsylvania.  BTW, the other nanny-states which restrict direct-to-consumer lab tests are New York and Rhode Island.

New York even restricts "blood-spot" testing (finger-prick) done at home and mailed in, which can be used for HbA1c, vitamin D, and other tests. To get around that, folks have had the tests mailed to friends or family in other states, who then forward it.  Our politicians are truly moronic.

Rich

Jim, I am right there with you... and Rich - thanks for the links I will be taking a look at that since I want to make sure I stay in good range without over doing my supplements.

Thanks Dr Davis for a great post, once again.

I'm a little concerned (as an RN), that the RN and the Pharm were under the impression D affected coagulation. Working in managed care, I see a ton of misconception. Im always astounded at how much a non issue nutrition is, with the exception of diabetics, renals, and your bariatric surgery patients. The only places that get it are centers like Memorial Sloan Kettering, taking a whole body approach. But even there, wrong MD on your case, and your sunk. Do not get sick, and if you do, don't try to heal in the average hospital.

I'm allergic to corn so I live in fear of having to be hospitalized. You can't even imagine all the ways they could make me sicker. The worst part is that my own doctor has told me that I couldn't possibly be reacting to a corn derivative because all the corn protein had been processed out. I can almost guarantee that they wouldn't have a medicine to treat me that didn't contain corn.

Thanks for this information.

How about a triglyceride level of 200 mg/dl, fatally high from the Track Your Plaque experience? (We aim for <60 mg/dl.) This is typical in people who follow the diets endorsed by agencies like the American Heart Association and the American Diabetes Association, organizations too eager to keep the money flowing from corporate sponsors and thereby offer us their advice based more on politics and less on health. Triglyceride levels of 200 mg/dl cause no symptoms.

Glyco-sylation occurs inside a cell's endoplasmic reticulum lumen when certain  carbohydrates  (in the form of N-linked oligo-saccharides) meld with a newly folded protein that gets translated into  a glyco-protein.  There are different rates of activation and de-activation  between glyco-sylated and un-glycosylated proteins; this affects how that protein migrates as it tries to perform it's job and how  glycation can induce degenerative states.  Tissue cells with endoplasmic reticulum stress can exasperate certain disease progression because such "stress" there promotes more glycosylation.

I couldn't agree more with the advice to test every 15 minutes as a means of discovering your own "sugar curve." When I tried this, I found that my own peak falls pretty consistently at 75 minutes after beginning a meal. Testing at 2 hours completely overlooks my highest blood glucose levels.

It's a particularly good technique for those folks whose A1c levels are higher than their fingersticks would predict...it's almost surely because they're doing their sticks way past their glucose peak.

When test strips cost up to a buck apiece, it may feel hard to justify using six or eight of them on a single meal--but what you learn may save tens of thousands in medical bills!

Another great article - thank you! I'm curious about your thoughts on controlled 1 hour blood sugars (mine are rarely over 110) but baseline levels that aren't much lower. Typically in the 95-105 range. I will get something in the 80s occasionally, but 100 is more common. I never really spike - even a high carb meal will only get me to 130s or so and that never really happens as I don't eat much sugar/starch at all.

Another quick question: You've mentioned a couple times recently about this way of eating being particularly good for VISCERAL fat. That is exactly what I've found. Tremendous benefits and I feel great. I have leveled out for a while (months) in fat loss, however, with a good amount of subcutaneous fat still present. Is there another protocol for getting after this type of fat? I'm already no wheat, low carb, paleo.

Thanks again for your excellent articles! Always learning something new.......

Do you have citations to support your statement that glycation occurs at BGs of 100 or more?  This is one of the more-commonly discussed issues on diabetes discussion boards--but folks are wont to ask for backup.

Regarding glycation specifically...

1. Do you agree that fructose ("frucation") causes more AGE than glucose?
2. What to you make of Ray Peat's assertion that poly-fats are much more glycalating than glucose?

"The so-called "advanced glycation end products," that have been blamed on glucose excess, are mostly derived from the peroxidation of the "essential fatty acids." The name, “glycation,” indicates the addition of sugar groups to proteins, such as occurs in diabetes and old age, but when tested in a controlled experiment, lipid peroxidation of polyunsaturated fatty acids produces the protein damage about 23 times faster than the simple sugars do." (Fu, et al., 1996)." - Ray Peat

Thanks for the great article!
I've just begun tracking blood sugars closely, changed my diet to one very low in carbs and no grains, and am determined to find ways to keep at it. I've started a blog just track my progress and keep me honest: http://transformation-transformative.blogspot.com/
I'll also try the 15 minute testing to see where my personal peak in blood sugar occurs.
Again, many thanks!

Hi Dr. Davis:  What is the relationship between fasting BG taken at the Dr's office and A!C?  My fasting BG level is 73.5 but my A1C is 5.4.  I would have expected the A1C to more correspond to the fasting measurement; in the case of my wife it does.  Is it related more to the red blood cells lingering around longer or lipoprotein particles which increases the chance of glycation?  Recently had a larger than normal amount of carbs in a meal- rice and blueberries and BG spiked to 119, not to bad, but will experiment with carb portion to keep under 100 as BG may be a contributing factor to my CAD.  I am also a hyperabsorber of fat despite being an ApoE 3/3.

As an aside, i have sent around a link of one of your interviews regarding Wheat Belly and many eyes have been opened as well as many looking to buy the book.  Might not be a bad idea to have a link to any of your interviews on Wheat Belly posted to this site.
Thanks for the enlightening good work!

Well said, Annabel!

Hi, Shottle--
This will be the topic of an upcoming discussion. The documentation of this effect is quite extensive. It is no longer a matter of "if" but "how much."

Hi, Jeff--
This is one of oranges and apples comparisons.
Fructose does indeed induce flagrant glycation. Glucose induces glycation, though less vigorously.

However, there is a separate but very poorly named process called exogenous glycation which has less to do with glycation than with oxidation of fats.

This will be the topic of future discussions.

My first thought is that, if weight loss is ongoing, there is a temporary situation of insulin resistance that generally dissipates with weight stabilization.

It's also possible that your pancreas has inadequate baseline production of insulin. I'm hoping it's the first possibility.

Hi, Steve-

You will find that, if you did frequent fingersticks around the clock, the highish A1c reflects the higher blood glucose values that occur after meals.

Thanks for the feedback on the Wheat Belly project. I will indeed crosslink some of the more relevant discussions.

Advanced glycation end products (AGE) involve some of haemoglobin's hydro-carbon Beta side chain valine residue linking up to non-polar "glucose" aldehyde compounds and certain non-"glucose" aldehydes. Various pathological kinds of AGEs can occur from distinct events; in one situation it is macrophage activity producing enzymatic myelo-peroxidase, which can activate hypochlorite favoring a serine amino acid wing to form up to make the AGE called glyco-aldehyde.

Probably the AGE called methyl-glyoxal is the one most relevant to diabetes prevention; since Type 1 diabetics blood serum levels of methyl-glyoxal is +/- 6 times higher than normal. This AGE can be formed when the byproduct triose-phosphate (triose = subset of carbs) is generated from the glycolytic pathway called  Embden-Meyerhof; this  byproduct risks being made into methyl-glyoxal.

Maybe the most well known AGEs are the non-enzymatic Amadori products formed via hydrolysis; one is called glyoxal coming from glucose oxidation. And the other Amadori type AGE is 3-deoxy-glucosone (3DG), which requires fructo-selysine and the fructos-amine 3 kinase cascade to shuffle together 3DG.

Diabetes reveals the problem with AGEs; this is because diabetics risk incurring kidney nephro-pathy, One of the pathological results is oxidative kidney stress, which limits sodium (Na) excretion thereby fostering  hyper-tension . When AGEs like 3DG, glyoxal & methyl-glyoxal  (among others, like pentosidine ) circulate into the kidneys their carbonyl compounds  are hard to clear by the kidneys; the side effect is to engender  uric uremia problems and meanwhile levels of carbonyls build up in what is called "carbonyl stress".
Japan research of the plant compound chamaemeloside found that in humans it lowered levels of the AGEs 3DG & pentosidne better than any other natural remedy; optimal response was reduction of down to 1/5 th of subject's starting levels.  Chamaemeloside is the active compound in chamomile (Anthemis noblis); the extraction formula was 1 Kg of chamomile flowers steeped covered in 20 Lt. water for 3 hours at 80* celcius ( a lab temperature probably not critical for home remedy preparation).

Volek and Phinney in their new book about carbohydrate restriction think that as you increase  fat from 30% to 60% of your diet, insulin resistance increases, then it drops when you go above 60%.  It seems that among the most experienced researchers of carbohydrate restriction, there's little consensus about the optimal amount of fat or carbs.  Ron Krausse, for instance, thinks 35% to 45% is optimal.

Peter:
When these researchers talk about carb levels are they considering vegetables to be carbs, or just fruits, grains, potatoes?

You must mean, "can exacerbate certain disease progression...." meaning: to increase the severity, violence, or bitterness of; aggravate

This is wonderful information BUT I wonder if it might be unfortunate if folks who routinely have post-prandials of 120 to 140 take your 100 level as a sign of "failure"...things are seldom so cut and dried, black and white. I don't know if I'm hitting 100 or less  after every meal, but my A1C has dropped from 7.5 to 5.8 since last November restricting carbs. And I've lost 30 pounds. I will begin to be more dogmatic about one-hour glucose checks but my rough sense is that I'm not at 100 or less a majority of the time. But I might be wrong about that. Do you see what I'm getting at? Glucose control is an ongoing process that includes lots of self education since most GP's are not keen AT ALL on restricting carbs, including mine. When I read your post, my initial feeling was, "Cripes, 100 after EVERY meal? Don't think I can do that...."

From another commentator here, in an  earlier thread of Dr. Davis' here is how to use HbA1c to determine your average blood glucose level (note: this is not a morning "fasting" level) .
1st: multiply your HbA1c by 28.7
2nd: subtract 46.7 from 1st amount
3rd: take last number as your average waking hours mg/dL blood glucose over last  few months  
ex:  HbA1c of 5.4 x 28.7 = 159.98 minus 46.7 = 108.28 mg/dL of average blood glucose level

They don't count non-starchy vegetable as carbs.

Thanks for the heads up!

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Dr. Davis,
I have found that if I take my carb level too low (below 50g per day) that my fasting blood glucose levels actually go up rather than down.  If my carb intake is closer to 70-80, my fasting glucose is lower.

Have you had this experience with some of your patients?  Can you shed any light onto what might be happening?

Thanks!
Stephanie

Non-starchy vegetables do have carbs and I do have to count them. A half cup of broccoli can have about 6 carbs and since I limit my carbs to no more than 15g/meal, that broccoli on my plate is significant.

I found getting a scale that reads carbs too was an important tool for me. I found I was ofter overestimating how much of a low carb veggie I could eat. If my blood sugar starts to rise, I go back to measuring and that seems to get me back on track.

Anne

I think thats normal, its commonly encountered on paleo forums/blogs. It has something to do with physiological insulin resistance, Petro @ Hyperlipid talked about. Look here:

http://high-fat-nutrition.blogspot.com/2007/10/physiological-insulin-resistance.html

I wouldn't suggest that everybody blindly follow CHO < 50g / day. As always, its about the context. People usually forget that. We mostly extrapolate from results of people who already have metabolic problems.

Anyway, I am currently perfectly healthy apart from some minor dermatology problems (eczema).
When I have prolonged periods of reduced CHO input (around 50g / day), I eventually start having some mucus problems. Dry eyes particularly, but also joint pain. I am not 100% sure if its about low carb diet, but it looks like it. Now I target 75g < CHO < 100g per day by adding small potato and a bit more chocolate to my diet.

I think overemphasizing carb reduction is not good thing for most people. Carbs should go down by pretty big amount for most people, but not to extreme. In anyway, its better to measure then to guess. My sugar is never above 110 after meal and fasting is always around 95.

I decided to take this advice and have been tracking my 60 mins postprandial blood glucose for the past two days to see if all the years I've been low carbing have been making any difference. Especially working my way through different foods to see how they affect me and I've ranged from 64 mg/dl to 97 mg/dl so I'm pretty hapy.

However this evening 60 minutes after my dinner of panfried steak with a creamy cajun sauce I got a reading of just 55 mg/dl. A lot of websites say this is too low. I'm 32, healthy male, 5,9", weigh 160 lbs, not diabetic and I don't feel sick so I'm not sure what to make of this low reading. The only thing I did was finish a hard CrossFit workout about 30 mins before I had dinner... so a total of 90 minutes before the blood glucose test.

Any advice on what this "low" reading means? I'm hoping it's normal and means I'm burning fat!

It's too bad that there is not a randomized, controlled trial to show the superiority of this strategy.  

Aside from assimilating scattered studies with surrogate endpoints, what would it take to definitively show that this strategy actually does improve cardiovascular morbidity and mortality?  

If Dr. Davis can convince many in the "thinking" public, surely someone in the health care industry or NIH would be interested in pursuing this.

Magnesium and Chromium are also important minerals.  Neither are particular common in most diets.  Perhaps, they would fit into a top 10 list.

I think regular testing is the most important strategy. If your tests come out okay, then there is no reason for anything else. If the test show problems, then address the problems in a methodical.

Many people don't appear to have any problems with wheat. I'm 50 and spent perhaps 10 years in my 30's getting most of my calories from pasta, and another ten years in my 40's getting most of my calories from oats. I was never more than 10 lbs overweight and I haven't visited a doctor in 30 years, other than for an ear wax buildup about 20 years ago. My test scores recently were good and I have good glucose tolerance according to the glucose monitor I recently bought (reli-on from walmart).

The reason I started investigating diet issues is that I felt lousy during two months on the Appalachian Trail this past fall. My diet on the trail consisted of nothing but a pound per day of instant rice and another pound of dry-roasted peanuts plus a multivitamin, and then a gallon of ice cream and a package or two of cookies and maybe some candy bars and cheese whenever I stopped off at town. Like most of the other hikers, my problem was not gaining weight but rather losing too much. Those binges on ice cream made me feel very sick afterwards. I began to have cravings for oats, which I think helps to keep the blood vessels clear. Now that I've gotten back to civilization, I've been eating lots of vegetables and oats and my blood pressure is typically under 100/70 (I bought a sphygomanometer as soon as I got home from the trail and my initial BP was 120/70). I think people who exercise as much as a typical backpacker have no problems with complex carbs. A gallon of ice cream and a full package of iced oatmeal cookies at one sitting is another story.

I found this blog after a search in April 2008 because my Fasting glucose had broken 100 (105) and I was worried I would end up a type 2 diabetic like my 90 year old dad. I began following the advice here: almost no wheat or grains, little sugar/fructose, added 8000 Vit D3, 12.5mg Iodoral, 2800mg omega-3 fish oil.  Now, my fasting glucose is 97, my Vit D went from 13(!) to 75.  I quit my statin and although my LDL went from 111 to 135, my HDL went from 60 to 74 and Trig from 108 to 62.  Lost 10 lbs without trying and now need to wear a belt.  The only thing I can complain about is my BP seems to stay around 130/74. Otherwise I'm convinced. Thank you, Dr. Davis.
Jay in CA.

Hi Dr. Davis

i've looked around your blog but did not find information on buckwheat flour, chickpeas flour and water chestnut flour.

i understand they are safe for celiacs to consume but how far are they consistent with the heart-good diet i've picked up from your blog so far? e.g. consumption amount per day if they are fine? things to watch out.

Thanks

revelo,

Have you had an NMR lipo test done? By your own description, being on such a high carb diet, your LDL particle numbers might shock you.

And don't fall into the same trap that most prototypical thin men fall into.  Just because you are thin and active does not give you a pass on following these strategies.  Look at this blog post by Dr. Davis:

Here's the prototypical male with lipoprotein(a)

"Several features stand out in the majority of men with lipoprotein(a), Lp(a):

Slender--Sometimes absurdly so: BMIs of 21-23 are not uncommon. These are the people who claim they can't gain weight.

Intelligent--Above average to way above average intelligence is the rule.

Gravitate to technical work--Plenty of engineers, scientists, accountants, and other people who work with numbers and/or technical details are more likely to have Lp(a).

Enjoy high levels of aerobic performance--I tell my Lp(a) patients that, if they want to see a bunch of other people with Lp(a), go to a marathon or triathlon. They'll see plenty of people with the pattern among the aerobically-elite.

I would recommend Nordic walking as an exercise.

Do you have information about the interference of wheat (or other neolithic pathogens) on thyroid-function? I would guess that either phytates hinder the absorbtion of iodine (both in humans as well as in animals we eat), or that gluten/gliadins/etc directly interfere with thyroid function, or trigger an autoimmune reaction (or all of the above...).

And from an similar area: You don't know by chance of any papers linking wheat with adrenal-gland problems?

Hi, Andrew--

In fact, I contemplated a "six strategies" that included magnesium.

I agree: magnesium is indeed near the top of the list for heart health.

Hi, Jay--

Good news: With the favorable changes you've witnessed, the calculated (or what I call "fictional") LDL cholesterol increases, while the genuine measurement (e.g., NMR LDL particle number or apo B) drops.

Of course, don't count on your friendly drug company to tell you this.


Hi, Tony--

The only connection I know of between wheat (gluten, in this case) and thyroid disease is that wheat exposure can activate (or at least be associated with) Hashimoto's thyroiditis, i.e., thyroid gland inflammation.

dr davis,

are you saying wheat mainly, that other carbs could be eaten and still some benefit could be had from just omitting wheat from diet?

What kind of magnesium is best for those who have the old "Phillips Milk of Magnesia" effect with normal magnesium supplements?

This is craaaaazy!!! Four days ago my BP was 150/100- I took your recommendations to hear, along with other supplements (whey, blueberries, coQ10, magnesium, olive leaf) + low carb + exercise and my blood pressure has dropped to 129/90. I cannot believe this.

What is most incredible is that all docs said my BP was 100% genetic and there was nothing I could do (probably b/c i'm thin and young).

I am blogging my progress. The goal is to get off that goddamn atenolol once and for all.

Here's a rundown of what I am doing. Any advice from anyone would be super welcome.

http://superhighbloodpressure.blogspot.com/p/details-of-experiment.html

BTW the one thing I am NOT doing is supplementing with iodine. Is this necessary? How does one know if thyroid function is wack? Any recommendations on what type of iodine to take?

You ever tire of your Sisyphean struggles, Dr D? Many people in the medical industrial complex simply do not give credence to your findings.

For example, I shared your point #1 (re wheat) with a research pathologist friend -- yes, the same fellow whose knowledge you believe might be circa 1985 -- and he said...
"The statements that you list are at best applicable under select circumstances.  I doubt there is any scientific evidence (study in a peer reviewed journal) to support your claims. If you stop eating, your triglycerides, weight, and  LDL will go down, nothing to do with stopping wheat. Similarly, in >99% of individuals, CRP levels are not related to diet, especially wheat eating. The only time eating wheat would make a difference is if you cannot tolerate wheat for any reason."

Which brings me back to my opening question. "Peer reviewed journal"...? I mean, c'mon, that is akin to waiting until everyone is bullish and owns a stock before you finally buy.

I found this abstract (with relation to celiac disease patients - poor bastards):

The American Journal of Gastroenterology (2001) 96, 751–757; doi:10.1111/j.1572-0241.2001.03617.x
Prevalence of thyroid disorders in untreated adult celiac disease patients and effect of gluten withdrawal: an Italian multicenter study
http://www.nature.com/ajg/journal/v96/n3/abs/ajg2001173a.html

OBJECTIVES:
Many afflictions have been associated with celiac disease, but chance associations may exists. The aim of this study was to establish, by means of a multicenter prospective study, the prevalence of thyroid impairment among adult patients with newly diagnosed celiac disease and to evaluate the effect of a 1-yr gluten withdrawal on thyroid function.

METHODS:
A total of 241 consecutive untreated patients and 212 controls were enrolled. In 128 subjects a thorough assessment, including intestinal biopsy, was repeated within 1 yr of dietary treatment. Thyroid function was assayed by measuring the levels of TSH, free T3, free T4, thyroperoxidase, and thyroid microsome antibodies.

RESULTS:
Thyroid disease was 3-fold higher in patients than in controls (p < 0.0005). Hypothyroidism, diagnosed in 31 patients (12.9%) and nine controls (4.2%), was subclinical in 29 patients and of nonautoimmune origin in 21. There was no difference regarding hyperthyroidism, whereas autoimmune thyroid disease with euthyroidism was present in 39 patients (16.2%) and eight controls (3.8%). In most patients who strictly followed a 1-yr gluten withdrawal (as confirmed by intestinal mucosa recovery), there was a normalization of subclinical hypothyroidism. Twenty-five percent of patients with euthyroid autoimmune disease shifted toward either a subclinical hyperthyroidism or subclinical hypothyroidism; in these subjects, dietary compliance was poor. In addition, 5.5% of patients whose thyroid function was normal while untreated developed some degree of thyroid dysfunction 1 yr later.

CONCLUSIONS:
The greater frequency of thyroid disease among celiac disease patients justifies a thyroid functional assessment. In distinct cases, gluten withdrawal may single-handedly reverse the abnormality.

You want to know, how to make exercise fun: check this one out: http://www.youtube.com/watch?v=2lXh2n0aPyw

Dr Davies

What do you think about consuming the Swedish innovation Oatly (trademark) that is a special  oatmilk with an elevated amount of betaglucans?
Professor Rickard Öste has developed this type of oatmilk.

Thank you for your efforts and blog.

RE Omega 3s, you recommend fish oil.  Is that preferable to getting Omega 3s from walnuts and ground flaxseed, both of which I understand to also provide Omega 3s?  Is there a benefit to fish oil vs. these other options?

Thank you.

Tom

Hi, David--

Great points.

Perhaps your pathologist friend should consider spending some time with the living.


Tom--

Those are two different things. Walnuts and flax do NOT provide the same effects as the omega-3s from fish, just as the oil in your car's engine cannot be used to be put in the gas tank. Two different, though related, things.

Ok, got'ca on the wheat, but what about oats? Same deal, or are they OK? I can cut out wheat without any problems, but I do like my oat porridge... ;)

Niacin was near the top  of your protocol list earlier.  Has this fallen out of favour?  Or is it just the insurance abuse which keeps it off the list?

I have recently been diagnosed with wheat & gluten IgE sensitivity.  So I will finally stop resisting the #1 rec.  After 4 days I am seeing some changes in eosinophilic esophaghitis, gingivitis, and rhinitis.

Oatlover?

Oats are an entirely different issue. They cause blood sugar to skyrocket.


Steve--

The newer focus on strict elimination of wheat, cornstarch, and sugars has reduced reliance on niacin considerably.

I'd put a caution note for the fish oil, we now know some of us get very bad opposite effect.

Okay, I'm not really that hung up on oats. But oat porridge is a main staple of mine. I'll take your advise and cut out wheat and oat for at least a few weeks and see what it's like.
I'm healthy and have no heart problems or blood sugar issues of any kind, but as I'm not getting any younger (about to turn 40), I'm hoping to prevent any future problems by finetuning my diet.

@Oatlover,

I had been eating oats as part of what I thought was a "healthy diet," but stopped when I started tracking my blood glucose and watched it consistently soar afterwards. I found oat bran had the same effect on my blood glucose. Since giving them up, I no longer get the light-headed tired hunger that used to force me to take lunch early. Since giving up wheat as well, I've never felt better.

Well wishes for your trial!

Dr Davis,

What you mean by: The newer focus on strict elimination of wheat, cornstarch, and sugars has reduced reliance on niacin considerably?
What is the relationship between wheat/corn starch and sugar and niacin dosage?
Is a lower dose of niacin efficient when wheat/corn and sugar are eliminated?

Stelucia

Here is the conventional wisdom of max 1,000 IU Vitamin D via the NYT: LINK

BALANCED DIET

Some time ago, I decided to try to understand the origin of the phrase "Balanced Diet". After a lot of Google searching, I landed on a page that sketched out the use of the term, and have since lost the link.

The term became popular, evidently, in about the 1920's and it was associated with the rapid discovery of many vitamins in foods. At that time, vitamin discoveries would seemingly pop up out of the blue.

One writer, the first in a chain, remerked that "under the circumstances (unknown vitamins lurking in the food supply), we should therefore eat as broadly as possible so as to take in as many potential vitamins as possible."

"Balanced Diet", under this interpretation, arose out of dietary ignorance, not dietary fact.

I understand that you don't like wheat and other grains.  Are beans good or bad?  

Yes, they are carbohydrate, but they're low glycemic index.  Are they a food which both anti-grain and USDA pyramid can agree are good, or do they have a down-side (other than gas)?

Could you replace wheat with oats or other grains?

For that matter, how about quinoa or polenta?

Thanks.

Hi, Ari--

No, no, no, and no.

These grains increase blood sugar to high levels in the majority of adults.

I will be discussing such grains in an upcoming post.

Hello DR WD.

Today I have for the first time read  "The Heart-Scan Blog" and was interested to read of your recommendations as to the five most powerful heart disease prevention strategies.  In my case "prevention" is a little late in the day since I was diagnosed with severe Congestive Heart Failure  in the autumn of 2008. My EF at that time was just 15% to 20% and a considerable area of the heart muscle was  a-kinetic.   Although the usual heart drugs were prescribed,   after a few months of feeling lack-lustre and devoid of energy, I decided to stop taking them and instead changed my diet and supplemented,  primarily with Ubiquinol. From barely being able to shuffle 20 metres or so I now readily walk about 4 miles a day. The diet  has seen one or two changes along the way but has  for the best part of the last two years been grain free. Lean and fatty meats and eggs by the dozen  are consumed  each and every week  as are lots of vegetables  and  oily fish.  Coconut oil, natural sea salt,  apple cider vinegar,  turmeric, cayenne pepper and Italian tinned tomatoes  all go into delicious home-made salsas that spice up the blandest of vegetables.   Processed oils are avoided but raw butter enjoyed without any restriction whilst  British, French and Swiss unpasteurised cheeses   figure strongly on my menu. All I can add is that on that diet I feel wonderfully reinvigorated.

Now we know who the sesinlbe one is here. Great post!

I had no idea how to approach this before—now I’m locked and leoadd.

tGQ3Jq  onymtvlhovpl

I found just what I was needed, and it was entertianing!

Alaakzaam—information found, problem solved, thanks!